Bill Amendment: FL S0684 | 2019 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Dental Therapy
Status: 2019-05-03 - Died in Children, Families, and Elder Affairs [S0684 Detail]
Download: Florida-2019-S0684-Senate_Committee_Amendment_972568.html
Bill Title: Dental Therapy
Status: 2019-05-03 - Died in Children, Families, and Elder Affairs [S0684 Detail]
Download: Florida-2019-S0684-Senate_Committee_Amendment_972568.html
Florida Senate - 2019 COMMITTEE AMENDMENT Bill No. SB 684 Ì972568TÎ972568 LEGISLATIVE ACTION Senate . House Comm: WD . 03/18/2019 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Children, Families, and Elder Affairs (Rader) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete lines 621 - 852 4 and insert: 5 (7) A dental therapist under the direct or indirect 6 supervision of a dentist may administer local anesthesia, 7 including intraoral block anesthesia or soft tissue infiltration 8 anesthesia, or both, if she or he has completed the course 9 described in subsection (5) and presents evidence of current 10 certification in basic or advanced cardiac life support. 11 (8)(7)A licensed dentist, or a dental therapist who is 12 authorized by her or his supervising dentist, may utilize an X 13 ray machine, expose dental X-ray films, and interpret or read 14 such films. NotwithstandingThe provisions ofpart IV of chapter 15 468to the contrary notwithstanding, a licensed dentist, or a 16 dental therapist who is authorized by her or his supervising 17 dentist, may authorize or direct a dental assistant to operate 18 such equipment and expose such films under her or his direction 19 and supervision, pursuant to rules adopted by the board in 20 accordance with s. 466.024 which ensure that said assistant is 21 competent by reason of training and experience to operate said 22 equipment in a safe and efficient manner. The board may charge a 23 fee not to exceed $35 to defray the cost of verifying compliance 24 with requirements adopted pursuant to this section. 25 (9)(8)NotwithstandingThe provisions ofs. 465.0276 26notwithstanding, a dentist need not register with the board or 27 comply with the continuing education requirements of that 28 section if the dentist confines her or his dispensing activity 29 to the dispensing of fluorides and chlorhexidinechlorohexidine30 rinse solutions; provided that the dentist complies with and is 31 subject to all laws and rules applicable to pharmacists and 32 pharmacies, including, but not limited to, chapters 465, 499, 33 and 893, and all applicable federal laws and regulations, when 34 dispensing such products. 35 Section 13. Subsection (1) of section 466.018, Florida 36 Statutes, is amended to read: 37 466.018 Dentist of record; patient records.— 38 (1) Each patient shall have a dentist of record. The 39 dentist of record shall remain primarily responsible for all 40 dental treatment on such patient regardless of whether the 41 treatment is rendered by the dentist or by another dentist, 42 dental therapist, dental hygienist, or dental assistant 43 rendering such treatment in conjunction with, at the direction 44 or request of, or under the supervision of such dentist of 45 record. The dentist of record shall be identified in the record 46 of the patient. If treatment is rendered by a dentist other than 47 the dentist of record or by a dental hygienist, dental 48 therapist, or dental assistant, the name or initials of such 49 person shall be placed in the record of the patient. In any 50 disciplinary proceeding brought pursuant to this chapter or 51 chapter 456, it shall be presumed as a matter of law that 52 treatment was rendered by the dentist of record unless otherwise 53 noted on the patient record pursuant to this section. The 54 dentist of record and any other treating dentist are subject to 55 discipline pursuant to this chapter or chapter 456 for treatment 56 rendered to the patient and performed in violation of such 57 chapter. One of the purposes of this section is to ensure that 58 the responsibility for each patient is assigned to one dentist 59 in a multidentist practice of any nature and to assign primary 60 responsibility to the dentist for treatment rendered by a dental 61 hygienist, dental therapist, or dental assistant under her or 62 his supervision. This section shall not be construed to assign 63 any responsibility to a dentist of record for treatment rendered 64 pursuant to a proper referral to another dentist who does notin65 practice with the dentist of record or to prohibit a patient 66 from voluntarily selecting a new dentist without permission of 67 the dentist of record. 68 Section 14. Section 466.0225, Florida Statutes, is created 69 to read: 70 466.0225 Examination of dental therapists; licensing.— 71 (1) Any person desiring to be licensed as a dental 72 therapist shall apply to the department to take the licensure 73 examinations and shall verify the information required on the 74 application by oath. The application must include two recent 75 photographs of the applicant. 76 (2) An applicant is entitled to take the examinations 77 required in this section and receive licensure to practice 78 dental therapy in this state if the applicant: 79 (a) Is 18 years of age or older; 80 (b) Is a graduate of a dental therapy college or school 81 accredited by the American Dental Association Commission on 82 Dental Accreditation or its successor entity, if any, or any 83 other dental therapy accrediting entity recognized by the United 84 States Department of Education. For applicants applying for a 85 dental therapy license before January 1, 2024, the board shall 86 approve the applicant’s dental therapy education program if the 87 program was administered by a college or school that operates an 88 accredited dental or dental hygiene program and the college or 89 school certifies to the board that the applicant’s education 90 substantially conformed to the education standards established 91 by the American Dental Association Commission on Dental 92 Accreditation; 93 (c) Has successfully completed a dental therapy practical 94 or clinical examination produced by the American Board of Dental 95 Examiners, Inc., (ADEX) or its successor entity, if any, if the 96 board finds that the successor entity’s examination meets or 97 exceeds the provisions of this section. If an applicant fails to 98 pass the ADEX Dental Therapy Examination after three attempts, 99 the applicant is not eligible to retake the examination unless 100 the applicant completes additional education requirements as 101 specified by the board. If a dental therapy examination has not 102 been established by the ADEX, the board shall administer or 103 approve an alternative examination; 104 (d) Has not been disciplined by a board, except for 105 citation offenses or minor violations; 106 (e) Has not been convicted of or pled nolo contendere to, 107 regardless of adjudication, any felony or misdemeanor related to 108 the practice of a health care profession; and 109 (f) Has successfully completed a written examination on the 110 laws and rules of this state regulating the practice of dental 111 therapy. 112 (3) An applicant who meets the requirements of this 113 section, and who has successfully completed the examinations 114 identified in paragraph (2)(c) in a jurisdiction other than this 115 state, or who has successfully completed comparable examinations 116 administered or approved by the licensing authority in a 117 jurisdiction other than this state shall be licensed to practice 118 dental therapy in this state if the board determines that the 119 other jurisdiction’s examinations and scope of practice are 120 substantially similar to those identified in paragraph (2)(c). 121 Section 15. Section 466.0227, Florida Statutes, is created 122 to read: 123 466.0227 Dental therapists; scope and area of practice.— 124 (1) The Legislature finds that authorizing licensed dental 125 therapists to perform the services specified in subsection (3) 126 would improve access to high-quality affordable oral health 127 services for all residents in this state. The Legislature 128 intends to rapidly improve such access for low-income, 129 uninsured, and underserved patients and communities. To further 130 this intent, a dental therapist licensed under this chapter is 131 limited to practicing dental therapy in the following settings: 132 (a) A health access setting, as defined in s. 466.003(16). 133 (b) A community health center, including an off-site care 134 setting. 135 (c) A nursing facility. 136 (d) A military or veterans’ hospital or clinic, including 137 an off-site care setting. 138 (e) A governmental or public health clinic, including an 139 off-site care setting. 140 (f) A school, Head Start program, or school-based 141 prevention program, as defined in s. 466.003(17). 142 (g) An oral health education institution, including an off 143 site care setting. 144 (h) A hospital. 145 (i) A geographic area designated as a dental health 146 professional shortage area by the state or the Federal 147 Government which is not located within a federally designated 148 metropolitan statistical area. 149 (2) Except as otherwise provided in this chapter, a dental 150 therapist may perform the dental therapy services as specified 151 in subsection (3) under the direct or indirect supervision of a 152 dentist to the extent authorized by the supervising dentist and 153 provided within the terms of a written collaborative management 154 agreement signed by the dental therapist and the supervising 155 dentist which meets the requirements of subsection (4). For 156 purposes of this section, the term: 157 (a) “Direct supervision” means supervision whereby a 158 dentist diagnoses the condition to be treated, a dentist 159 authorizes the procedure to be performed, a dentist remains on 160 the premises while the procedures are performed, and a dentist 161 approves the work performed before dismissal of the patient. 162 (b) “Indirect supervision” means supervision whereby a 163 dentist authorizes the procedure and a dentist is on the 164 premises while the procedure is performed. 165 (3) Dental therapy services include all of the following: 166 (a) All services, treatments, and competencies identified 167 by the American Dental Association Commission on Dental 168 Accreditation in its Dental Therapy Education Accreditation 169 Standards. 170 (b) The following state-specific services, if the dental 171 therapist’s education included curriculum content satisfying the 172 American Dental Association Commission on Dental Accreditation 173 criteria for state-specific dental therapy services: 174 1. Evaluating radiographs. 175 2. Placement of space maintainers. 176 3. Pulpotomies on primary teeth. 177 4. Dispensing and administering nonopioid analgesics 178 including nitrous oxide, anti-inflammatories, and antibiotics as 179 authorized by the supervising dentist and within the parameters 180 of the collaborative management agreement. 181 5. Oral evaluation and assessment of dental disease and 182 formulation of an individualized treatment plan if authorized by 183 a supervising dentist and subject to any conditions, 184 limitations, and protocols specified by the supervising dentist 185 in the collaborative management agreement. 186 (4) Before performing any of the services authorized in 187 subsection (3), a dental therapist must enter into a written 188 collaborative management agreement with a supervising dentist. 189 The agreement must be signed by the dental therapist and the 190 supervising dentist and must include: 191 (a) Practice settings where services may be provided by the 192 dental therapist and the populations to be served by the dental 193 therapist. 194 (b) Any limitations on the services that may be provided by 195 the dental therapist, including the level of supervision 196 required by the supervising dentist. 197 (c) Age- and procedure-specific practice protocols for the 198 dental therapist, including case selection criteria, assessment 199 guidelines, and imaging frequency. 200 (d) A procedure for creating and maintaining dental records 201 for the patients who are treated by the dental therapist. 202 (e) A plan to manage medical emergencies in each practice 203 setting where the dental therapist provides care. 204 (f) A quality assurance plan for monitoring care provided 205 by the dental therapist, including patient care review, referral 206 followup, and a quality assurance chart review. 207 (g) Protocols for the dental therapist to administer and 208 dispense medications, including the specific conditions and 209 circumstances under which the medications are to be dispensed 210 and administered. 211 (h) Criteria relating to the provision of care by the 212 dental therapist to patients with specific medical conditions or 213 complex medication histories, including requirements for 214 consultation before the initiation of care. 215 (i) Supervision criteria of dental therapists. 216 (j) A plan for the provision of clinical resources and 217 referrals in situations that are beyond the capabilities of the 218 dental therapist. 219 (5) A supervising dentist may restrict or limit the dental 220 therapist’s practice in a collaborative management agreement to 221 be less than the full scope of practice for dental therapists 222 which is authorized in subsection (3). 223 (6) A supervising dentist may authorize a dental therapist 224 to provide dental therapy services to a patient before the 225 dentist examines or diagnoses the patient if the authority, 226 conditions, and protocols are established in a written 227 collaborative management agreement and if the patient is 228 subsequently referred to a dentist for any needed additional 229 services that exceed the dental therapist’s scope of practice or 230 authorization under the collaborative management agreement. 231 (7) A supervising dentist must be licensed and practicing 232 233 ================= T I T L E A M E N D M E N T ================ 234 And the title is amended as follows: 235 Delete lines 48 - 72 236 and insert: 237 direct or indirect supervision of a dentist to 238 administer local anesthesia and utilize an X-ray 239 machine, expose dental X-ray films, and interpret or 240 read such films if specified requirements are met; 241 correcting a term; amending s. 466.018, F.S.; 242 providing that a dentist remains primarily responsible 243 for the dental treatment of a patient regardless of 244 whether the treatment is provided by a dental 245 therapist; requiring the initials of a dental 246 therapist who renders treatment to a patient to be 247 placed in the record of the patient; creating s. 248 466.0225, F.S.; providing application requirements and 249 examination and licensure qualifications for dental 250 therapists; creating s. 466.0227, F.S.; providing 251 legislative findings and intent; limiting the practice 252 of dental therapy to specified settings; authorizing a 253 dental therapist to perform specified services under 254 the direct or indirect supervision of a dentist under 255 certain conditions; defining the terms “direct 256 supervision” and “indirect supervision”; specifying 257 state-specific dental therapy services; requiring a 258 collaborative management agreement to be signed by a 259 supervising dentist and a dental therapist and to 260 include certain information;